Pathways for lower extremity superficial vein thrombosis management in an academic medical center

There is currently no established management pathway for lower extremity superficial vein thrombosis (SVT), leading to significant uncertainty among front-line providers. This study aimed to assess prescribing practices and patient outcomes for the initial treatment of lower extremity SVT. This descriptive retrospective cohort study in a single center included consecutive patients with radiographically diagnosed acute lower extremity isolated SVT between January 1, 2016 and December 31, 2021. Exclusions were chronic SVT, concomitant deep vein thrombosis or pulmonary embolism, required anticoagulation for another indication, or no documented SVT treatment plan. This 6-year study included 265 patients. The majority received conservative therapy as the SVT management strategy (n=188, 70.9%), while 23% (n=61) received anticoagulation therapy. Few patients received no treatment (n=13, 4.9%) or surgery (n=3, 1.1%). The most common strategy in those utilizing anticoagulation was a VTE treatment-dose DOAC, but the duration varied considerably (11.5% 30 days or less, 37.7% 31-45 days, 21.3% for 46-90 days, and 24.6% >90 days). Ninety-day progression to VTE occurred in 8 patients (3.1%, 2 in the anticoagulation therapy group and 6 in the conservative therapy group). Bleeding occurred in 6 patients (2.3%, 4 in the conservative therapy group and 2 in the anticoagulation group).  Over a six-year period, there were varying pathways of managing acute lower extremity SVT without a concerning signal in adverse events with any single treatment approach. Future study should focus on which patients benefit from anticoagulation therapy vs conservative therapy and clarifying the optimal anticoagulation treatment intensity and duration.